Price Sylvie D, Holman C D'Arcy J, Sanfilippo Frank M, Emery Jon D
The University of Western Australia, Perth, Australia.
Ann Pharmacother. 2014 Jan;48(1):6-16. doi: 10.1177/1060028013504904. Epub 2014 Jan 6.
Predisposition to adverse drug events with advancing age has led to the development of lists of potentially inappropriate medications (PIMs) to be avoided in the elderly, such as the Beers Criteria. The prevalence of Beers medications has been studied widely, but it is still unclear whether PIM use is predictive of adverse events in older people.
To examine potential associations between exposure to PIMs from the general Beers list and unplanned hospitalizations in elderly Western Australians.
Using an enhanced case-time-control design and conditional logistic regression applied to the pharmaceutical claims and other linked health data of 251 305 Western Australians aged ≥65 years (1993-2005), odds ratios for unplanned hospitalization were obtained, from which attributable fractions, number and proportion of hospitalizations associated with drug exposure were derived.
Based on the health profiles of 383 150 hospitalized index subjects, overall PIM exposure was associated with an elevated risk of unplanned hospitalization (adjusted odds ratio = 1.18; 95% confidence interval = 1.15-1.21), this estimated risk increasing with the number of different PIMs and PIM quantity taken. Fifteen percent of unplanned hospitalizations in exposed index subjects (1980 per year) were attributed to PIM exposure. Patients taking meperidine (pethidine), nitrofurantoin, promethazine, indomethacin, and thioridazine appeared to be at particularly high risk of unplanned hospitalization, whereas temazepam, oxazepam, diazepam, digoxin, amiodarone, ferrous sulfate, and naproxen were attributed the greatest numbers of unplanned hospitalizations.
Due caution prescribing Beers medications in the elderly seems justified, paying particular attention to PIMs listed above and to the concurrent use of multiple PIMs. Our results also support the retention of specific medications on PIM lists in future developments.
随着年龄增长，药物不良事件的易感性促使了一系列潜在不适当药物（PIM）清单的制定，以供老年人避免使用，如《Beers标准》。对符合《Beers标准》的药物的流行情况已进行了广泛研究，但PIM的使用是否能预测老年人的不良事件仍不清楚。
研究西澳大利亚州老年人接触《Beers标准》中一般PIM清单与非计划住院之间的潜在关联。
采用强化病例-时间-对照设计和条件逻辑回归，应用于251305名年龄≥65岁的西澳大利亚人的药品报销及其他相关健康数据（1993 - 2005年），得出非计划住院的比值比，由此推导出归因分数、与药物暴露相关的住院人数及比例。
基于383150名住院索引对象的健康状况，总体PIM暴露与非计划住院风险升高相关（调整后的比值比 = 1.18；95%置信区间 = 1.15 - 1.21），该估计风险随不同PIM的数量和服用的PIM剂量增加而增加。暴露的索引对象中15%的非计划住院（每年1980例）归因于PIM暴露。服用哌替啶（度冷丁）、呋喃妥因、异丙嗪、吲哚美辛和硫利达嗪的患者似乎非计划住院风险特别高，而替马西泮、奥沙西泮、地西泮、地高辛、胺碘酮、硫酸亚铁和萘普生导致的非计划住院人数最多。
在老年人中谨慎开具符合《Beers标准》的药物似乎是合理的，尤其要关注上述PIM以及多种PIM的同时使用。我们的结果也支持在未来的发展中保留PIM清单上的特定药物。
